Rejected

Pediatric intracranial aneurysms (PIA) are very rare and can be fatal if left untreated. There are many treatment strategies including microsurgical and endovascular techniques. We feel that endovascular treatment using trans-radial access (TRA) is safe and convenient for PIA compared to the trans-femoral access (TFA), which is commonly employed in this population. We present the case of the youngest patient in the world whose ruptured aneurysm was treated with endovascular coiling via the TRA. The seven-year-old patient was brought to the ER with a severe headache. He had several episodes of vomiting and an episode of seizure as well. Computerized tomography (CT) of the brain showed subarachnoid hemorrhage. A magnetic resonance angiogram (MRA) showed an aneurysm at the bifurcation of the right internal carotid artery (ICA). An intermediate catheter/microcatheter system was used to navigate up into the ICA and then into the aneurysm. Two coils were deployed with good packing. The patient had a good clinical recovery and is currently doing good without any neurological deficits. With the availability of newer devices, we believe the TRA will be widely used in the coming years. We need to have larger randomized controlled trials to really understand the advantages of TRA in this patient population.

Preeclampsia is characterized by hypertension and proteinuria, which is associated with kidney injury. Glycocalyx (GCX) degradation mediated endothelial injury can result in proteinuria and kidney damage. alpha 7 nicotinic acetylcholine receptor (α7nAChR) connects nervous and immune systems to respond to stress or injury. We aimed to explore the protective effect and mechanism of intraspinal analgesia on maternal kidney injury in preeclampsia. Endotoxin-induced preeclampsia rats treated with ropivacaine via intraspinal administration. Renal histopathological examination was performed, cell apoptosis in the kidney, the levels of Glycocalyx markers of Syndecan-1 and heparin sulfate (HS) in maternal serum, Syndecan-1 along with α7nAChR in the kidney were measured. Our results showed that kidney injury was obviously in preeclampsia rats with proteinuria, endothelial damage, higher apoptosis rate, increasing levels of Syndecan-1 and HS in serum, upregulated Syndecan-1 expression but downregulated α7nAChR expression in kidney. Preeclampsia rats treated with intraspinal injected ropivacaine attenuated preeclampsia-induced kidney injury as Syndecan-1 and HS were decreased in serum, Syndecan-1 expression was suppressed as well as α7nAChR was activated in the kidney. Our results suggested that Ropivacaine administered through the spinal canal may protect preeclampsia-induced renal injury by decreasing GCX and α7nAChR activation.

Cigarette smoking is a risk factor for hip fractures, while risk factors for developing delirium include older age and preexisting cognitive impairment. We sought to determine whether smoking status is independently associated with delirium and pain outcomes.

The objective of this study was to determine whether burrowing behavior may be useful as a functional index of pain in both female and male rats, and whether a "no-training" protocol can be used, to increase efficiency of testing. Adult Sprague-Dawley rats were injected in one hindpaw with oil vehicle or complete Freund's adjuvant (CFA), and then placed individually into cages containing a burrowing tube filled with aquarium gravel; the amount of gravel burrowed out of the tube after 1 h was measured each day for up to 7 days. To test the predictive validity of the burrowing test as a screen for analgesic effect, rats were pretreated with the non-steroidal anti-inflammatory drug (NSAID) ketoprofen (0.001-3.2 mg/kg) or the opioid morphine (0.1-3.2 mg/kg) as standard analgesics (true positives). Chlordiazepoxide (1.25-10 mg/kg) was tested as a true negative, and delta-9-tetrahydrocannabinol (THC, 0.01-2.0 mg/kg) was tested as a purported analgesic. CFA reliably suppressed burrowing in both sexes for 2-3 days, using a "no-training" protocol. In regard to predictive validity, ketoprofen restored CFA-suppressed burrowing in both sexes by days 2-3, and was more potent in females than males. In contrast, morphine only restored CFA-suppressed burrowing in males. Chlordiazepoxide further decreased CFA-suppressed burrowing in males, and did not alter burrowing behavior in females. THC did not significantly alter CFA-suppressed burrowing in either sex, up to doses that decreased burrowing in oil-treated controls. These results suggest that in male rats (as others have shown), burrowing is a useful, functional index of inflammatory pain. Furthermore, training/habituation to the burrowing procedure is not necessary. In contrast, although female rats' burrowing behavior is suppressed by CFA to approximately the same extent as males', only the NSAID restored CFA-suppressed burrowing in females. Additional studies are underway to determine the extent to which CFA dose (i.e., pain intensity) and analgesic pretreatment time contribute to the limited efficacy of analgesics in the burrowing test, particularly on the first day after CFA injection.

Neurovascular syndrome is a dysfunction of an individual cranial nerve which is compressed by vessels. Several neurovascular compression syndromes are well known such as trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia. Having neurovascular conflicts at oculomotor nerves and abducens nerve cause ocular neuromyotonia and abducens nerve palsy. Site of compression is still controversial because of unclear definition. The term root entry/ exit zone (REZ) is defined variously and used interchangeably with transitional zone making it hard to compare between studies. It is generally thought to be at transitional zone which is defined as junction between central and peripheral nervous system. Lately, central myelin and transitional zone of trigeminal, facial, and glossopharyngeal nerves has been studied with clear definition. However, microanatomical knowledge about oculomotor and abducens nerves is limited. The aim of study was to evaluate microanatomy of central myelin and transitional zone of both nerves. Twenty-nine oculomotor and 53 abducens nerves were obtained from 46 cadavers' brains but only 10 of each nerve were included. These specimens were serially sectioned, stained, and photographed under the microscope. Five distances were measured: diameter of cranial nerve, extent of central myelin, diameter of transitional zone, depth of transitional zone, and length of central myelin on the far side of the brainstem. Length of central myelin was 2.75 ± 0.83 mm in oculomotor nerve and 1.66 ± 1.39 mm in abducens nerve. Longest central myelin length was 4.30 ± 1.26 mm in oculomotor nerve and 1.88 ± 1.40 mm in abducens nerve. Depth of transitional zone was 0.23 ± 0.07 mm in oculomotor nerve and 0.16 ± 0.08 mm in abducens nerve. Length of the central myelin portion on the far side of the brainstem was 1.47 ± 0.90 mm in oculomotor nerve and 1.42 ± 1.50 mm in abducens nerve. Positive weak correlation between depth of transitional zone and length of central myelin of each nerve bundle in oculomotor nerve (r +0.310, p<0.05) and abducens nerves (r +0.413 p<0.05) were found. Depths of transitional zone varied between nerves and nerves bundles. Transitional zone usually takes up to 20% of central myelin. For oculomotor nerve, longest central myelin was seen on first nerve bundles and then length of central myelin was gradually decreased from lateral to medial side. For abducens nerves, morphology patterns were classified into type A-D which type A and B tend to have longer segment of central myelin than type C and D. Also, longer central myelin tends to have longer transitional zone in both nerves. Detail of microanatomy of central myelin and transitional zone is clearly stated. Clinicians could benefit from well-defined parameters which help to locate lesion precisely and understand etiology more. Moreover, it is previously known that peripheral myelin is more resistant to compression compared to central myelin so knowing microanatomy of cranial nerves could provide safer surgeries.

Despite enormous advancements of reproductive medicine, recurrent implantation failure and habitual abortion remain an ongoing issue. One of the most important aspects of successful implantation is the intricate immune regulation necessary for the acceptance of the hemiallogenic embryo. The most numerous immune cells in the decidua are uterine Natural Killer (uNK) cells. Studies suggest that changes in the uNK cells count and physiology may be responsible for the aforementioned conditions. Thus, the uNK cells testing may provide valuable insights into their pathogenesis.

People exposed to ultrasonic frequencies have symptoms that include fatigue, headache, insomnia, irritability, lack of concentration, and other symptoms (Hocking, 2001; Johnson Liakouris, 1998). Drosophila have been model organisms in experiments for decades, leading to advancements in science. The ability to reproduce quickly, short-generation time, and well-defined fully sequenced genome make drosophila the ideal candidate for studies related to behavioral genetics and neurophysiology. Third instar larvae (Child et al., 1981) and Drosophila Pupa (Fritz-Niggli and Boni, 1950) have been shown to be sensitive to pulses of ultrasound. Here we investigate how repeated ultrasonic frequency exposure impact learning and memory in adult Drosophila.

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used as analgesic and anti-inflammatory drugs. However, adverse effects, including gastrointestinal, renal, cardiovascular side effects, seriously complicate NSAIDs use. Their gastrointestinal side effects are the most known serious complications in patients taking these drugs. Previously we have shown that preconditioning stress attenuates the ulcerogenic action of indomethacin (IM) on the gastric mucosa. According our findings glucocorticoids, released in response to stressor, are gastroprotective hormones and involved in stress preconditioning protective effects. Corticotropin releasing factor (CRF), a major mediator of stress response, stimulates ACTH release through CRF receptors of subtype 1 and ACTH, in turn, stimulates glucocorticoid production. Here we verify the hypothesis that pharmacological preconditioning by CRF or ACTH can protect the gastric mucosa against ulcerogenic action of IM in rats through mechanism associated with glucocorticoids. For this, preliminary fasted (24 h) rats were administered by CRF (2.5 or 5 µg/ kg, ip) or ACTH (1U/kg, ip) 30 min before IM injection (35 mg/kg, sc). Gastric lesions were examined 4 h after IM administration. Plasma corticosterone levels were measured before and 4 h after IM injection. Since the gastrointestinal injury is accompanied by changes in somatic pain sensitivity, we also measured tail flick latencies (tail flick test) before and 4 h after IM. Both CRF and ACTH by itself caused an elevation of plasma corticosterone levels, which was accompanied by an increase of tail flick latencies (analgesic effect). IM administration resulted in the gastric erosion 4 h later. Pretreatment with CRF or ACTH reduced an area of gastric lesions caused by IM (gastroprotective effect). IM-induced gastric injury was accompanied by an increase of tail flick latencies, which was prevented by CRF (normalization of somatic pain sensitivity). To estimate the role of glucocorticoids in CRF-induced gastroprotection an inhibitor of corticosterone synthesis metyrapone (30 mg/kg) or CRF receptor type 1 antagonist NBI 27914 (10 mg/kg) or glucocorticoid receptor antagonist RU-38486 (20 mg/kg) was administered before CRF. Both metyrapone and NBI 27914 injected before CRF administration caused an inhibition of CRF-induced corticosterone response and prevented protective effect of CRF on the gastric mucosa against the IM-induced injury. The gastroprotective effect of CRF was also eliminated by the pretreatment with RU-38486. Thus, CRF as well as ACTH can protect the gastric mucosa against ulcerogenic action of IM. Gastroprotective action of CRF accompanied by normalization of somatic pain sensitivity is provided by mechanism associated with glucocorticoids.

Pain is a common and distressing symptom in people living with cancer that requires a patient-centred approach to management. Since 2010, the Australian Government has invested heavily in developing regional cancer centres to improve cancer outcomes. This study explored patient and carer experiences of care from a regional cancer centre with specific reference to cancer pain management.